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SITREP - Happy New Year

Happy New and welcome to our first issue of 2009. This month’s issue focuses on the SOMA conference. There was a lot of good information put out and we want to pass it on to you. We also had some controversy that we’ll discuss later.

The was information we want to get to you includes TCCC updates, some controversy on hemostatic agents, and over all report on SOMA events.

We’re a little late with this months issue and we apologize. The staff at Vighter has been caught up in personal, national and world events. We hope you’ll understand and we’ll try to do better in the future

Field Practice - TCCC update for 2008

In last months issue, we sent a link to the 2008 update for TCCC. This month we want to briefly outline key changes in TCCC. At the SOMA conference, CPT Butler had selected members of the TCCC committee discuss changes to TCCC. First of all, you can find changes to TCCC at the Institute for Surgical Research website. The address is http://www.usaisr.amedd.army.mil/tccc.html.

1. The first change is under CUF (care under fire). No hemostatic agents are recommended during CUF. Primary hemorrhage control is with tourniquets. (PLEASE SEE UPDATES FOR CLARIFICATIONS)
2. Recommended tourniquets are the CAT and SOF-T. There is also a recommendation for the military pneumatic tourniquet in healthcare facilities. During CUF, tourniquets should be place high on an extremity directly over the clothes. Tramatic amputations should have tourniquets placed 2 to 3 inches proximal to the wound. During tactical field care (TFC), tourniquets should be replaced to be under clothes and proximal to the wound site. You should check for a distal pulse and if present apply a second tourniquet. Tourniquets should be exposed and the patient marked. (PLEASE SEE UPDATES FOR CLARIFICATIONS)
3. The only two recommended hemostatic agents are Combat Gauze (primary) and WoundStat (secondary). The efficacy studies are very clear that these two outperform anything else that is out there. There is some controversy about WoundStat discussed later in this issue of Vighter News. (PLEASE SEE UPDATES FOR CLARIFICATIONS)
4. Tension pnuemothorax should be decompressed with a 3.25 inch 14 gauge needle. Needle should be placed as always in the 2nd ICS midclavicular line, but should NOT be medial to the nipple line and NOT directed towards the heart. (PLEASE SEE UPDATES FOR CLARIFICATIONS)
5. During TFC, sucking chest wounds should be treated with an occlusive material and secured. No three-sided dressings. (PLEASE SEE UPDATES FOR CLARIFICATIONS)
6. Penetrating eye trauma should be assessed by rapid visual acuity, covered with a rigid eye shield and treated with Moxifloxicin 400mg or IM/IV antibiotics as recommended by TCCC. (PLEASE SEE UPDATES FOR CLARIFICATIONS)
7. This issue probably won’t apply to us since we all use different types of documentation. There is a new TCCC causality card that is recommended by the committee. (PLEASE SEE UPDATES FOR CLARIFICATIONS)
8. The last issue is on verbage. The term CASEVAC is being changed to TACEVAC. (PLEASE SEE UPDATES FOR CLARIFICATIONS)

As we repeatedly stated above - PLEASE SEE UPDATES FOR CLARIFICATIONS! If you still have a question, we will be happy at Vighter News to help you find an answer.

Gizmos and Gadgets: Woundstat™ On Hold

There was some controversy at this year's SOMA conference concerning the use of Woundstat.

Dr. Bijan Keiribaldi from the USAISR presented preliminary data showing emboli and unsuccessfully reanastimosis in the carotid artery of animal models. This was non-peer reviewed, unpublished data from a pilot study, but Dr. Keiribaldi felt strong enough about it to present it at SOMA. Since then, the Army has halted distribution of WoundStat pending a review and further study. The TCCC committee is due to meet the 3rd through the 4th of February and we expect an update on WoundStat at that time. We will pass on whatever we find out to you. Traumacure, the makers of WoundStat were contacted for a statement that we will have in next months issue. Below we have a link ot the AP story about WoundStat.

"The Army halts use of Woundstat to study more. Recent study showed that, if used directly on injured blood vessels, the granules may lead to harmful blood clots." By PAULINE JELINEK, AP

Click for the full article: Woundstat article

2008 SOMA Conference Link

We were hoping to provide you with a link to this year slides from the SOMA conference. We are told that the slides have not yet been posted. When the slides are available, we will provide you a link so you can review them. This could prove to be a valuable training tool to you as you train on your own in remote areas. In the mean time, we have the link below.

A look at the Special Operations Medical Association Conference.

SOMA Conference

Feedback: What people said at SOMA

We were pleased to run into a number of readers while at the SOMA conference. All the comments we received about the newsletter were positive. Was this just a friendly gesture? The one comment we heard multiple times is that no one else is providing this information for medics working in private security. We are pleased to provide this service. One individual told us it was like having a surgeon’s office putting out information for the medics. Thanks to those who gave us feedback.

JOBS:

The only recruiter we saw at the SOMA conference looking for medics was Blackwater. They are actively looking for former 18D’s. You can go to Blackwater’s website for more information.

Editorial Staff

Editor-in-Chief: Jeffrey A. Lee, MD, MPH vighetrnews@vighter.com

Managing Editor: Jon Holmes vighternews@vighter.com

Format Editor: Bob Sherron vighternews@vighter.com

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